Doctoral Dissertation Research: Death and Survival in a Pandemic: A Bioarchaeological Investigation of Frailty and Resilience

本论文探讨了人类生物变异如何影响流感大流行中的死亡和生存风险。研究人员检查了在流感大流行中死亡的人的骨骼遗骸，以了解脆弱(定义为疾病和死亡的可能性增加)和弹性如何影响死亡风险。除了增加有关生物脆弱性的科学知识外，该项目还将帮助研究人员了解社会规范如何造成直接影响健康和死亡率的不平等。研究人员将收集代表性不足群体的公共卫生数据，创建关于边缘人群流感发病率和严重性可能存在差异的有价值的信息。因此，该项目将有助于实现2020年健康人目标，这是一项旨在改善所有美国人健康的政府倡议。该项目将确定增加一个人在过去的流感大流行中死亡风险的风险因素，帮助科学家预测未来的流感爆发可能如何影响现代人口。这项研究将为第一代女大学生提供STEM领域的培训、实验室方法和统计，并为她提供更多与其他领域的学者合作的机会。显然，虚弱的人总是比健康和有弹性的人更有可能死亡。然而，在1918年西班牙流感大流行期间，20-40岁的年轻人是最有可能死亡的人群之一。关于为什么看似健康的年轻人在这次大流行中死亡人数创历史新高，有很多理论，但没有人质疑这些年轻人是否真的健康。这些人是否存在某种潜在的弱点，或者大流行是否真的杀死了适应力强的人？这个项目将通过回答以下问题来探索1918年流感大流行中影响死亡率和存活率的因素：1)虚弱的人是否更有可能在西班牙流感大流行期间死亡？2)更有弹性的人是否更有可能在西班牙流感大流行中幸存下来？3)年龄、性别和种族等人口因素是否会影响脆弱和韧性？哈曼-托德收藏的人类骨骼遗骸是1918年大流行期间在俄亥俄州克利夫兰死亡的个人的集合，将被检查以寻找脆弱和韧性的骨骼标记。这些数据将使用一种名为危险分析的统计分析进行分析，该分析显示死亡风险如何随着时间的推移而变化，以应对特定的情况。结果将显示在大流行期间，虚弱的人和有韧性的人的死亡风险是如何变化的。这一奖项反映了NSF的法定使命，并通过使用基金会的智力优势和更广泛的影响审查标准进行评估，被认为值得支持。

This dissertation explores how human biological variation influenced the risk of death and survival in a major influenza pandemic. The researchers examine human skeletal remains of people who died during an influenza pandemic to understand how frailty (defined as the increased likelihood of disease and death) and resilience impacted the risk of mortality. In addition to increasing scientific knowledge of biological vulnerability, this project will help researchers understand how social norms create inequalities that directly impact health and mortality. The researchers will collect public health data on underrepresented groups, creating valuable information on how influenza incidence and severity may vary in marginalized populations. This project will therefore contribute to the goals of Healthy People 2020, a government initiative to improve the health of all Americans. This project will identify risk factors that increased a person’s risk of dying in a past influenza pandemic, helping scientists predict how a future influenza outbreak may affect modern populations. This research will provide a female first-generation college student with training in a STEM field, laboratory methods, and statistics, as well as additional opportunities for her to collaborate with scholars in other fields.It seems obvious that a person who is frail should always be more likely to die than someone who is healthy and resilient. However, during the Spanish Influenza pandemic of 1918, young adults between the ages of 20-40 were among the most likely to die. There are many theories as to why seemingly healthy young adults died in record numbers during this pandemic, however no one has questioned whether the young people were actually healthy. Was there some underlying frailty in these individuals or was the pandemic truly killing resilient people? This project will explore the factors that influenced mortality and survival in the 1918 pandemic by answering the following questions: 1) Were frail individuals more likely to die during the Spanish Influenza pandemic? 2) Were more resilient individuals more likely to survive the Spanish Influenza pandemic? 3) Do demographic factors such as age, sex, and race influence frailty and resilience? Human skeletal remains from the Hamann-Todd collection, an assemblage of individuals who died in Cleveland, Ohio, during the 1918 pandemic will be examined for skeletal markers of frailty and resilience. These data will be analyzed using a type of statistical analyses called hazards analysis that shows how the risk of death changes over time in response to certain circumstances. The results will show how the risk of death varied during the pandemic in individuals who were frail versus those who were resilient.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.